title: Parent-administered exposure to increase children's vegetable acceptance: a randomized controlled trial.
abstract: BACKGROUND
  Repeated taste exposure, in combination with small rewards, has been shown to increase children's acceptance of disliked foods. However, previous studies have used direct contact with researchers or professionals for the implementation of the repeated exposure procedure. If mailed taste exposure instructions to parents produced comparable outcomes, this could be a cost-effective and easily disseminable strategy to promote healthier diets in children.
  
  
  OBJECTIVE
  Our randomized controlled study aimed to test the efficacy and acceptability of mailed materials giving instructions on taste exposure as a means of increasing acceptance of vegetables in preschool-aged children.
  
  
  METHODS
  Participants were families of 3-year-old twins from the Gemini cohort who took part between March 2011 and April 2012. Families were randomized to a mailed intervention or a no treatment control condition. The intervention involved offering each child 14 daily tastes of a disliked (target) vegetable with a small reward (a sticker) if the child complied.
  
  
  METHODS
  Outcomes were the child's intake of the target vegetable (number of pieces) and parent reports of the child's liking at two baseline (T1 and T2) and one postintervention (T3) behavior assessment.
  
  
  RESULTS
  Record sheets with intake and liking data from T1, T2, and T3 were returned for 472 children, of which 442 were complete (94%). Over the intervention period (T2 to T3) intake and liking of the target vegetable increased significantly more in the intervention group than in the control group (intake: odds ratio 12.05, 95% CI 8.05 to 18.03, P<0.001; liking: odds ratio 12.34, CI 7.97 to 19.12, P<0.001). Acceptability of the procedure was very high among parents who completed the protocol.
  
  
  CONCLUSIONS
  Mailed instructions for taste exposure were effective in increasing children's acceptance of an initially disliked vegetable. These results support the value of parent-administered exposure to increase children's vegetable acceptance, and suggest that it can be carried out without direct health professional contact.
authors.forename: Alison
authors.initials: A
authors.lastname: Fildes
authors.forename: Cornelia H M
authors.initials: CHM
authors.lastname: van Jaarsveld
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
authors.forename: Lucy
authors.initials: L
authors.lastname: Cooke
mesh_terms: D002652:Child Behavior; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005518:Food Preferences; D055951:Functional Food; D006293:Health Promotion; D006801:Humans; D008297:Male; D018673:Nutrition Policy; D010287:Parent-Child Relations; D010290:Parents / Q000193:education; D010349:Patient Compliance; D010353:Patient Education as Topic; D057240:Patient Preference; D010988:Play and Playthings; D011177:Postal Service; D012201:Reward; D006113:United Kingdom; D014675:Vegetables
keywords: Children; Exposure; Food preferences; Vegetables